PubMed · 12744199
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José M Zuniga. 2003. Needed: committed and daring voices.. https://pubmed.ncbi.nlm.nih.gov/12744199/
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OBJECTIVE: To determine whether data from voluntary counseling and testing (VCT)/prevention of mother-to-child transmission (PMTCT) programs can be used for HIV surveillance. METHODS: Women attending an antenatal clinic at the district hospital in Entebbe, Uganda, from May 2002 to April 2003 were offered counseling and HIV testing with same-day results (VCT) and nevirapine for PMTCT was provided for HIV-positive women and their babies. Those who declined VCT were tested for HIV anonymously. RESULTS: Overall, 2635 women accepted VCT; 883 were tested anonymously. HIV prevalence was higher in VCT than in anonymously tested women in the first month of the program (20% vs. 11%, P=0.05) and in months with <70% VCT uptake (17% vs. 8%, P<0.001) but was similar in months with high uptake. Uptake of VCT was higher in women who had risk factors for HIV, especially those who believed themselves to have been exposed (84% vs. 73%, P<0.001). CONCLUSION: There was a bias to accepting VCT in women with HIV, or risk factors for HIV infection, the former most apparent when there was low coverage. Data from VCT/PMTCT programs cannot replace anonymous surveillance for monitoring of HIV epidemic trends where coverage is incomplete within clinics or communities.
OBJECTIVES: We sought to estimate HIV incidence among injection drug users (IDUs) in New York City from 1990 to 2002 to assess the impact of an expansion of syringe exchange services. Syringe exchange increased greatly during this period, from 250,000 to 3,000,000 syringes exchanged annually. METHODS: Serum samples were obtained from serial cross-sectional surveys of 3,651 IDUs. HIV-positive samples were tested with the Serologic Test Algorithm for Recent HIV Seroconversion (STARHS) assay to identify recent HIV infections and to estimate HIV incidence. Consistency with other incidence studies was used to assess strengths and limitations of STARHS. RESULTS: HIV incidence declined from 3.55/100 person-years at risk (PYAR) from 1990-1992, to 2.63/100 PYAR from 1993-1995, to 1.05/100 PYAR from 1996-1998, and to 0.77/100 PYAR from 1999-2002 (P<.001). There was a very strong negative linear relationship (r= -.99, P<.005) between the annual numbers of syringes exchanged and estimated HIV incidence. These results were highly consistent with a large number of shorter incidence studies among IDUs conducted during the time period. CONCLUSIONS: STARHS testing of samples from large serial cross-sectional surveys can provide important data for the assessment of community-level HIV prevention.
Well into the third decade of the human immunodeficiency virus (HIV) epidemic, rates of HIV infection remain high, especially among minority populations. Of newly diagnosed HIV infections in the United States during 2003, CDC estimated that approximately 63% were among men who were infected through sexual contact with other men, 50% were among blacks, 32% were among whites, and 16% were among Hispanics. Studies of HIV infection among young men who have sex with men (MSM) in the mid to late 1990s revealed high rates of HIV prevalence, incidence, and unrecognized infection, particularly among young black MSM. To reassess those findings and previous HIV testing behaviors among MSM, CDC analyzed data from five of 17 cities participating in the National HIV Behavioral Surveillance (NHBS) system. This report summarizes preliminary findings from the HIV-testing component of NHBS, which indicated that, of MSM surveyed, 25% were infected with HIV, and 48% of those infected were unaware of their infection. To decrease HIV transmission, MSM should be encouraged to receive an HIV test at least annually, and prevention programs should improve means of reaching persons unaware of their HIV status, especially those in populations disproportionately at risk.